OPEN ENROLLMENT Marianne Nicoletti, Oswald Companies January 7, - - PowerPoint PPT Presentation

• Marianne Nicoletti, Oswald Companies

January 7, 2016

OHIO ASSOCIATED ENTERPRISES

OPEN ENROLLMENT

AGENDA

• 2016 Open Enrollment
• What’s new for 2016
• Your Medical Plan
• Your Dental Plan
• Your Life Insurance Plan
• Next Steps

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2016 OPEN ENROLLMENT

• Open Enrollment is January 8th – January 18th
• All enrollments and changes must be made during Open

Enrollment

• Open enrollment is the one time during the year that you are able

to make changes to your plans. If you previously waived coverage, you may now enroll in the plan & if you are currently covered & wish to add dependents, you may do so as well

• The only other time during the year that you have the ability to make

changes to the plan is if you experience a Qualifying Event, such as a loss of coverage, divorce or marriage. If you do experience a Qualifying Event, please contact HR within 30 days of the event to complete the necessary paperwork

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WHAT’S NEW FOR 2016

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• Medical – slight change to prescription

copays and minor increase in cost

• Dental – no change in plan design with

a minor increase in cost

• Life Insurance – no change in plan

design or cost

Healthcare Reform

• Beginning in 2014, all Americans are required to purchase health insurance, or pay a

penalty

• Individuals can either obtain coverage through their employer-sponsored health plan
• r they can purchase coverage on their own
• Open Enrollment in the Marketplace (Exchange) opens on November 1, 2015

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FORM 1095-C

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FORM 1095-C

• In January you will receive two form 1095-C(s):
• One from Ohio Associated Enterprises
• One from Anthem
• These forms will need to be filed with your 2015 tax

return.

• The tax ruling applies to all full-time, benefits eligible

employees regardless of their enrollment status within the benefits plan.

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FORM 1095-C

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MEDICAL

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WHAT’S NEW FOR 2016 - MEDICAL

• Medical Plan changes include:
• Prescription Drugs – Retail
• Tier 4 – the monthly maximum is $250 (from $200)
• Prescription Drugs – Mail Order
• Tier 1 – increased to $20 (from $10)
• Tier 2 – increased to $105 (from $88)
• Tier 3 – increased to $210 (from $175)
• Tier 4 – the monthly maximum is $250 (from $200)
• These changes are based on the way Anthem filed their

plans for 2016

• Premium Contributions – slight increase in employee

cost

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2016 MEDICAL PLAN

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BENEFITS

H.S.A. Deductible (Single/Family) $2,600/$5,200 Coinsurance 0% after Deductible Out-of-Pocket Maximum (Single/Family) $3,500/$7,000 Office Visit (PCP/Specialist) 0% after Deductible Inpatient Hospital Services 0% after Deductible Outpatient Surgical Services 0% after Deductible Diagnostic Services 0% after Deductible Emergency Room Services 0% after Deductible Urgent Care 0% after Deductible Retail Rx (30-day) – copays double after 3rd fill at retail Mail Order Rx (90-day) $10/$35/$70/ 25% to $250 max, after deductible $20/$105/$210/ 25% to $250 max, after deductible

New in 2016: All covered expenses (including Deductible, Coinsurance & both Medical/Rx Copays) accumulate towards the Maximum Out-of-Pocket

• This is an illustration of In-Network benefits, but please note that the plan does also provide

coverage outside of the network. Please refer to the plan documents for details & final confirmation of coverage

ELIGIBILITY

LIGIBILITY FOR FOR HSA’

HSA’S

• Be covered under an HDHP on the first day of the month that

the account is established and the first day of the month in which deposits are made.

• Not also be covered under any other health plan that is not an
• HDHP. Certain types of limited benefit plans may be ok, such as

a cancer policy, accident policy or a fixed daily benefit policy (hospital indemnity).

• Not be entitled to benefits under Medicare.
• Not be claimed as a dependent on another person’s tax return.

HSA Eligibility

In order to be eligible to make pre-tax contributions to a Health Savings Account, individuals must:

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QUALIFIED

UALIFIED MEDICAL EDICAL EXPENSES XPENSES

These Expenses are Eligible for Reimbursement from an HSA:

• Spinal Fluid Test
• Splints
• Sterilization
• Therapy Equipment
• Vaccines
• Vasectomy
• Vitamins (if prescribed)
• Wheelchairs
• X‐Rays
• Diagnostic Testing
• Drug Addiction Therapy
• Eyeglasses
• Hospital Bills
• Hearing Aides
• Insulin Treatments
• Lab Tests
• Operating Room Costs
• Oral Surgery
• Organ Transplant
• Orthopedic Shoes
• Oxygen & equipment
• Physician Services
• Physiotherapist Services
• Postnatal Treatments
• Prenatal Care
• Prescription Drugs
• Psychiatrist Services
• Psychologist Services

This is just a partial list of the eligible HSA expenses. Please visit the IRS website & Publication 502 for a complete listing.

• Alcoholism Treatment
• Ambulance
• Anesthetists
• Arch Supports
• Artificial Limbs
• Blood Tests
• Braces
• Contact Lenses
• Chiropractic Visits
• Crutches
• Dental Treatments/X-Rays
• Dentures
• Dermatologist Visits

Eligible Expenses

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*Always make sur e the amount the pr

• vide r

says you owe matc he s the amount the E OB indic ate s owe d be for e se nding payme nt.

*Pr e se nt ID c ar d to ne twor k doc tor . *Do NOT pay for me dic al se r vic e s at the time of se r vic e . *You will pay for R x at the phar mac y. *Doc tor se nds me dic al c laim to Anthe m. *Anthe m applie s ne twor k disc ount and notifie s doc tor

• f amount you

may owe . *Whe n you have c laim ac tivity, you will r e c e ive an E xplanation of Be ne fits (E OB) fr

• m

Anthe m showing how the c laim was pr

• c e sse d & the

amount that you

• we .

*Doc tor bills you for payme nt.

• 1. You c an use your

HSA to pay.

• 2. Or

you c an c hoose to pay anothe r way (c ash, c r e dit c ar d) and r e imbur se your se lf fr

• m your

HSA late r .

How the HSA Plan Works

HSA Payment Process

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HSA RECORDKEEPING

• K

e e p yo ur re c e ipts a nd o the r fo rms (E OBs)

• Yo u must ke e p re c o rds suffic ie nt to pro ve to I

RS tha t:

• Withdra wa ls fro m HSA we re fo r q ua lifie d me dic a l e xpe nse s;

a nd

• T

he e xpe nse wa s no t pa id fo r o r re imb urse d b y a no the r so urc e o r ta ke n a s a n ite mize d de duc tio n

• Yo u c a n withdra w mo ne y fro m yo ur HSA to re imb urse yo urse lf

fo r e xpe nse s pa id in a prio r ye a r a s lo ng a s the y we re inc urre d

• n o r a fte r the da te the HSA wa s e sta b lishe d

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HSA RECORDKEEPING

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• T

he b a nk re po rts a ll withdra wa ls a nnua lly

• n F
• rm 1099 SA
• Yo u re po rt the a mo unt
• f withdra wa ls use d fo r

q ua lifie d me dic a l e xpe nse s o n yo ur ta x re turn

• Yo u must file F
• rm 8889

a s pa rt o f the ir a nnua l ta x re turn.

HSA CONTRIBUTION LIMITS

2015 2016 Self-only Coverage $3,350 $3,350 Family Coverage $6,650 $6,750 Catch-up Provision (for aged 55+) $1,000 $1,000

• Contributions can be made through pre-tax payroll deductions
• Employees can make after tax deposits directly and claim the

deduction when filing their tax return

• The totals include what the employer and employee contribute

collectively

Meritec will contribute $250 for each individual who enrolls in the plan in the first year, then will provide a match up to $75 per pay.

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• Preventive care is covered at

100%

• Flu shots are covered under

preventive (at 100%)

• Regular preventive care

helps reduce risk of disease

• Detect health problems early
• Protect you from higher costs

down the road

• May potentially save your life

No deductible. No copayment. No coinsurance. 100% coverage.

PREVENTIVE CARE

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Anthem Member Website

• Anthem Care Comparison

Tool

• Health & Wellness

Resources

• Health & Wellness

Discounts

• Plan Information
• Claims & EOB’s
• MyHealth@Anthem
• Future Moms
• ConditionCare Programs
• ComplexCare
• 24/7 NurseLine

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ACCOUNT SELF-SERVICE SOLUTIONS

• Integrated dashboard

displaying balance and recent claim activity

• Online payments or

reimbursement

• Download forms
• Manage investments
• Obtain answers to FAQs
• Education video library
• Year-to-date information (for

tax returns)

• Order checks and debit

cards

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Single sign-on link from Anthem.com

mobile provider directory mobile ID card

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Easier and less expensive than urgent care.

What is LiveHealth Online?

LiveHealth Online is a convenient way for employees to interact with a doctor via live, two-way video on their computer or mobile device. LiveHealth Online:

• Is available anywhere you have an internet connection
• Is available 24 hours a day/7 days a week
• Provides access to in-network, U.S. board-certified

doctors

• Offers help at the same price as (or less than) a regular

doctor visit

• Doctors can ePrescribe to local pharmacies (where

applicable)

• Takes member payments via credit card
• Register securely, and conveniently online

LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.

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LIVEHEALTH ONLINESM

www.livehealthonline.com

• Online healthcare when

you need it

• Immediate, life

consultants

• Choice of physicians

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DENTAL

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DENTAL PLANS - 2016

Anthem Benefits

In-network Out-of-network Deductible (Single/Family) $50/$150 $50/$150 Class I (Preventive) 100% 80% Class II (Basic) 80% 50% Class III (Major) 50% 50% Class IV (Ortho) 40% 40% Annual Maximum $1,000 $1,000 Lifetime Max. - Orthodontia $1,000 $1,000

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LIFE INSURANCE COMPANY PAID

• 100 % Employer Paid
• Life Insurance Benefit amounts are one time your annual

salary

• Ensure that you complete the Beneficiary form
• If you do not have a named beneficiary, the insurance company

will not know where to send the money

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VOLUNTARY LIFE INSURANCE

• 100% Employee paid
• Employee amounts
• Multiples of ½ up to 3 x salary (or $500,000)
• Guarantee issue amount of $100,000 when first eligible
• Spouse amounts
• Increments of $5,000 up to 50% of employee elected amount
• Guarantee issue amount of $25,000
• Child amounts
• Increments of $2,000 up to $10,000
• Guarantee issue amount of $10,000
• Evidence of Insurability is required for additional

amounts or if you are enrolling for the first time (not a new hire)

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WHAT PAPERWORK DO I NEED TO COMPLETE?

All employees MUST complete:

• Benefit Election Form – Please indicate whether you are electing or

waiving the medical, dental & vision coverage. This form must be returned by January 18th

• An Anthem Enrollment Form – if you are enrolling in the medical,

dental or the voluntary life for the first time

All forms must be returned by January 18th

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QUESTIONS?

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